Obesity due to medical problems. Rare? Common?

[LionelHutz405]

How common is obesity due to medical problems? (Rather than overeating.)

I would include any drugs with a side-effect of weight gain to be ‘medical’.

[Crafter_Man]

IANAD, but I think medically-induced obesity can be classified into the following categories:

1. There is a condition (I forget the name) where hunger signals are constantly sent to the brain. All the person wants to do is eat, eat, eat.

2. I believe there’s a disease where the body wants to store an inordinate amount of food as fat.

3. Depression.

With the possible exception of #2, all obesity is ultimately caused by overeating and/or lack of activity.

[susan]

Diabetes. Thyroid problems. Kluver-Bucy Syndrome. General metabolic problems. Hormone dysregulation. Etc.

A great many antipsychotic medications also cause weight gain and may be a factor in the development of type II diabetes; it’s also thought by some that schizophrenia itself may be related to the development of diabetes (based on studies of never-medicated folks with schizophrenia).

[Shagnasty]

@Crafter_Man

With the possible exception of #2, all obesity is ultimately caused by overeating and/or lack of activity.

Consuming more calories than you burn is responsible for 100% of obesity. It is just that some medical conditions make it easier to become obese. With most of these conditions it would be theoretically possible for someone to be on a calorie restricted diet and exercise much more than they normally would and remain in the normal weight range. I am not saying this is practical, doable, or wise but it does make it clear that there is no one that passively gains weight by existing and so there may be other solutions to try.

[Guinastasia]

@Crafter_Man

IANAD, but I think medically-induced obesity can be classified into the following categories:

1. There is a condition (I forget the name) where hunger signals are constantly sent to the brain. All the person wants to do is eat, eat, eat.

Prader-Willis. It’s not just obesity-it’s a mild form of mental retardation. People with this illness constantly feel on the verge of starvation, and no form of will power will work-they’ve been known to eat the stuffing from sofas, etc. It’s really very sad.

[Carol_the_Impaler]

PCOS can cause obesity.

From here:

Many women with PCOS have a weight problem, so researchers are looking at the relationship between PCOS and the body’s ability to make insulin. Insulin is a hormone that regulates the change of sugar, starches and other food into energy for the body’s use or for storage. Women with PCOS make too much insulin causes the ovaries to react and make too many male hormones. Insulin also disrupts how you make eggs, creating irregular cycles. The disruption in normal functioning of the ovary in PCOS can lead to acne, excessive hair growth, weight gain and ovulation problems.

Often, women with PCOS are insulin resistant. According to Elizabeth Lee Vliet, MD, author of The Savvy Woman’s Guide to PCOS, “The majority of women with PCOS tend to produce excessive amounts of insulin. High levels of insulin stimulate the ovaries to make more of the androgens, and also make you store more fat, instead of burning fat for fuel. Insulin resistance makes you get fatter and fatter, even if you are eating less and exercising more. The the fatter you get, the more insulin resistant you become.”

[astro]

It really depends on what you classify as a “medical problem”. My metabolism is slightly slow compared to most people, and my it takes a few minutes for my stomach to tell my brain that “enough is enough” instead of having simultaneous eat>satiation alert feed back. Neither “problem” is a big deal by itself, and it would be a non-issue in a non-industrial society that emphasized physical labor, but as it is, if I didn’t count calories I would be the size of a walrus.

It’s less the point that people have “medical issues”. Per **Crafter Man’s ** point the vast majority of obesity in modernity is the result it tendencies & behaviors that would normally be no big deal in a non-industrial society, but can creep up on you quickly in physically sedentary modern society where food is relatively abundant & cheap

[Kent_Clark]

Depending on your definition of “medical problems,” what about arthritis? Inflamed joints make it painful to move around, so the patient reduces activity, which leads to weight gain, which makes it even more difficult to move around, and so on.

[MLS]

@kunilou

Depending on your definition of “medical problems,” what about arthritis? Inflamed joints make it painful to move around, so the patient reduces activity, which leads to weight gain, which makes it even more difficult to move around, and so on.

Theoretically the person so afflicted could reduce his/her calorie intake do match the reduced level of activity. In practice this is very, very difficult. The pattern described is also very real. Been there, done that. Add to this that the arthritic is more likely to be an older person, for whom it’s already difficult to maintain the same weight as when younger.

The same pattern can start during a period of enforced idleness, such as when recovering from serious injuries.

A doctor and physical therapist can help a person to keep the joints more flexible, train specific muscles to bear more of the load, do exercises that don’t cause pain, and use appropriate analgesics to lessen the pain enough to move around more.
Until I was in phsyical therapy I had no idea there were beneficial exercises one could do while lying down.

[Zoe]

niblet_head, you have just made sense of my life!

I was diagnosed with PCOS in the mid-1960’s – although then it was called Stein-Leventhal Syndrome. I had no idea until reading your post that it was tied in with insulin at all. But this explains my low blood sugar problems. Thanks for that eye-opener!

I did know that it was probably one of the factors relating to my struggles with weight control. Depression is another.

One of the medications that I take is Topomax. It was originally developed for use in controlling seisures, but noticeably also supressed some compulsive behaviors: eating, shopping, etc.

I believe that weight problems related to chemical imbalances are probably very common.

[cerberus]

It would be interesting to do a study comparing BMI of people with these disorders across country … I suspect that American Portion/Sedentary Syndrome does alopt to exacerbate the problems.

To answer the question one would need a cohort of people with whatever condition and then randomly assign dietary/activity plans, and then study them prospectively.

Having said all of this, I suspect that the majority of people who are overweight or obese in the US got that way honestly: too much caloric intake and too little activity (both volitional). But there are clinically driven cases of overweight, including cases of PCOS and hyothyriodism, among others. Diabetes Mellitus and Overweight have a complicated relationship, but if anything, overweight drives/accelerates DM, not the other way around…

High Caloric Intake -> Hyperglycemia -> Weight Gain, Hyperglycemia -> Overweight, Hyperinsulemia, Hypercholesteremia -> Diabetes Mellitus

[Carol_the_Impaler]

@Zoe

niblet_head, you have just made sense of my life!

I was diagnosed with PCOS in the mid-1960’s – although then it was called Stein-Leventhal Syndrome. I had no idea until reading your post that it was tied in with insulin at all. But this explains my low blood sugar problems. Thanks for that eye-opener!

I did know that it was probably one of the factors relating to my struggles with weight control. Depression is another.

One of the medications that I take is Topomax. It was originally developed for use in controlling seisures, but noticeably also supressed some compulsive behaviors: eating, shopping, etc.

I believe that weight problems related to chemical imbalances are probably very common.

Well, now the circle is complete, because it was here on the SDMB that PCOS was first brought to my attention.

BTW, Zoe, I have printed off on of your posts about how to live life and I re-read it all the time. You have helped me make sense of my life!!

[kanicbird]

@Shagnasty

Consuming more calories than you burn is responsible for 100% of obesity

Well this is a convienent saying that while true (well it’s not really true*), has very little real life application.

• Some calories are not digestable, but consumable.

[astro]

@kanicbird

Well this is a convienent saying that while true (well it’s not really true*), has very little real life application.

• Some calories are not digestable, but consumable.

I’m not sure what point you’re making relative to the real world relationship of caloric intake and obesity. CM’s statement is perfectly true for the vast majority of obesity as it occurs in the US. When someone uses the word “calorie” in a discussion about diet they are obviously talking about the energy *available * in the food and this is the way calories are measured (see below).

Since you’re citing CM’s statement as “non-true” in some meaningful sense relative to “real life application” in a discussion of obesity, please give additional context. Your statement by itself doesn’t make much sense at all.

The “calorie” has become a common household term as dietitians recommend in cases of obesity to reduce body weight by increasing exercise (energy expenditure) and reducing energy intake. Many governments require food manufacturers to label the energy content of their products, to help consumers control their energy intake. In Europe, manufacturers of prepackaged food must label the nutritional energy of their products in both kilocalories (“kcal”) and kilojoules (“kJ”). In the United States, the equivalent mandatory labels display only “Calories” (meaning kilocalories); an additional kilojoules figure is optional. The energy content of food is usually given on labels for 100 g and for a typical serving size.

The amount of food energy in a particular food could be measured by completely burning the dried food in a bomb calorimeter, a method known as direct calorimetry [1]. However, the values given on food labels are not determined this way, because it overestimates the amount of energy that the human digestive system can extract, by also burning dietary fiber. Instead, standardized chemical tests and an analysis of the recipe are used to estimate the product’s digestable constitutents (protein, carbohydrate, fat, etc.). These results are then converted into an equivalent energy value based on a standardized table of energy densities

[rhiannon777]

I have PCOS. Despite eating 1200 calories a day (the absolute minimum recommended for any woman) and exercising for an hour to an hour and a half every day, I am obese. I’m glad to see people finally acknowledging that not all heavy people are lazy slobs.

Many, many medications (such as lithium for bipolar disorder, pretty much all drugs for schizophrenia, some types of birth control pills, the steroid treatments for Crohn’s disease, etc.) have weight gain as a side effect.

[Bippy_the_Beardless]

@astro

I’m not sure what point you’re making relative to the real world relationship of caloric intake and obesity. CM’s statement is perfectly true for the vast majority of obesity as it occurs in the US. When someone uses the word “calorie” in a discussion about diet they are obviously talking about the energy *available * in the food and this is the way calories are measured (see below).

Since you’re citing CM’s statement as “non-true” in some meaningful sense relative to “real life application” in a discussion of obesity, please give additional context. Your statement by itself doesn’t make much sense at all.

Though undoubtedly true that more calories -> more obesity, here is an interesting article from New Scientist showing that the source of the calories even within a calorie controled diet for monkeys can lead to different amounts of fat deposits.

New Scientist article

@New Scientist

They fed one group of African green monkeys a diet with 8 per cent of its calories from trans fats, equivalent to one fast-food burger-and-fries meal a day. The other group ate the same amount of total fat - 35 per cent of total calories - but without the trans fat. Both groups ate the same total calories, just enough for subsistence.

After six years on the diet, trans fat-fed monkeys gained an extra 7.2 per cent of their body weight, compared to just 1.8 per cent in the control monkeys. They also had 30 per cent more abdominal fat, which increases the risk of diabetes and heart disease.

[susan]

I have PCOS. Despite eating 1200 calories a day (the absolute minimum recommended for any woman) and exercising for an hour to an hour and a half every day, I am obese. I’m glad to see people finally acknowledging that not all heavy people are lazy slobs.

Same here, though I eat 1600 on medical advice. It literally takes 1.5 hours of exercise a day to stay at my current weight. It took years to convince any doctor that I wasn’t lying about my intake and activity level. I’m now taking Metformin and it seems to help a little–I had to take a 5-day course of steroids last fall and my weight went up 30 pounds despite no other changes in intake or activity on my part. This is medically acknowledged–when I told my internist I had taken steroids, he laughed and told me not to weigh myself for 6 months.

[Carol_the_Impaler]

I forgot to add (as an answer to the OP’s question) that PCOS is the most common endocrine disorder of women, affecting as many as 1 in 10.

[gigi]

Do you consider food addiction (if you acknowledge that it exists) a medical problem?

[Crafter_Man]

@rhiannon777

I have PCOS. Despite eating 1200 calories a day (the absolute minimum recommended for any woman) and exercising for an hour to an hour and a half every day, I am obese. I’m glad to see people finally acknowledging that not all heavy people are lazy slobs.

Many, many medications (such as lithium for bipolar disorder, pretty much all drugs for schizophrenia, some types of birth control pills, the steroid treatments for Crohn’s disease, etc.) have weight gain as a side effect.

First of all, if you’re fat – and it sounds like you are – then you’re eating too much and/or not getting enough physical activity.

Secondly, not all calories are equal. Let me explain.

We are fond of saying, “calories in, calories out.” But this is not entirely accurate, because your body processes fat differently than carbs & protein. It takes a lot more work for your body to convert carbohydrates to fat than fat to fat. According to this article,

The conversion of carbohydrates or protein into fat is 10 times less efficient than simply storing fat in a fat cell.

Not only that, but the consumption of *saturated *fat increases cholesterol. For both of these reasons, doctors recommend limiting the intake of fat.

Also check out this study, which says,

This figure shows the results of a meta-analysis of 37 diet intervention studies, conducted in a total of 9276 subjects who were given the National Cholesterol Education Program’s Step I or Step II reduced-fat diets (<30% of total energy intake from fat) [1]. The data show that decreasing dietary fat was directly associated with a decrease in body weight. Changes in percent dietary fat were also highly correlated with changes in energy intake. For every 1% decrease in energy from fat there was a corresponding 0.28 kg weight loss. The broken line illustrates that a 10% decrease in the percent of calories from fat was associated with a 3-kg decrease in body weight.

And yet another thing to consider: very few people count calories. Almost every person regulates the amount of food they eat based on volume. So if someone replaces volumetric fat with volumetric protein & carb, then they will ***automatically ***consume fewer calories. So this is yet another reason for cutting out fat from your diet… when you cut out fat, you ***tend ***to consume fewer calories.

Yet another thing to consider: weight loss is *primarily *achieved through eating less. Let me repeat: weight loss is primarily achieved through eating less. Of course, exercise certainly helps (since exercise burns calories and increases stress hormone levels). But weight loss is *primarily *achieved through eating less. The NIH agrees. In this article they say:

An increase in physical activity is an important component of weight loss therapy, although it will not lead to substantially greater weight loss over 6 months. Most weight loss occurs because of decreased caloric intake.

So again, weight training / exercise is very important. And while it can certainly be an ***aid ***in losing weight (via burning energy, stress hormone levels, etc.), weight loss is ***primarily ***achieved through eating less.